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Delayed enhancing lesions after coil embolization of aneurysms: clinical experience and benchtop analyses

 Se Won Oh  ;  Na Young Shin  ;  Ho-Joon Lee  ;  Byung Moon Kim  ;  Dong Joon Kim 
 Journal of Neurointerventional Surgery, Vol.9(12) : 1243-1247, 2017 
Journal Title
 Journal of Neurointerventional Surgery 
Issue Date
Adult ; Blood Vessel Prosthesis/adverse effects ; Blood Vessel Prosthesis/trends ; Embolization, Therapeutic/adverse effects ; Embolization, Therapeutic/trends ; Endovascular Procedures/adverse effects* ; Endovascular Procedures/trends ; Female ; Follow-Up Studies ; Humans ; Intracranial Aneurysm/diagnostic imaging* ; Intracranial Aneurysm/surgery* ; Intracranial Embolism/diagnostic imaging* ; Intracranial Embolism/etiology ; Intraoperative Complications/diagnostic imaging* ; Intraoperative Complications/etiology ; Magnetic Resonance Imaging/trends ; Male ; Middle Aged ; Prospective Studies ; Retrospective Studies ; Time Factors ; Treatment Outcome
Catheter ; Coil ; Embolic
BACKGROUND: Foreign body emboli during endovascular treatment (EVT) may cause delayed enhancing lesions (DELs). OBJECTIVE: To report our experiences of this complication in patients treated for cerebral aneurysms and to investigate the cause of the lesions by benchtop analyses. METHODS: Three patients with DELs on MRI after EVT were retrospectively investigated. Unusual friction had occurred in the midst of coil delivery in two patients. The imaging findings, cause of the lesions due to the devices used for the procedure, treatment, and follow-up results were assessed. Two benchtop analyses were performed. First, a microcatheter that showed similar unusual friction during coiling was retrieved and dissected at the point of friction. Second, the EVT procedure was simulated with multiple coil advancement and withdrawal maneuvers within an acutely angulated microcatheter to identify downstream foreign body material emboli. RESULTS: The DELs were identified 27-37 days (mean 32.7) after the procedure. The patients presented with left arm weakness, headache, and no other symptoms. The lesions were located in the hemisphere corresponding to the treatment. The symptoms subsided after conservative therapy. The dissected microcatheter showed whitish semitransparent material adherent to the inner lumen. Similar material was sieved after multiple coil advancement and withdrawal maneuvers. CONCLUSIONS: DELs may be caused by fragmentation and emboli of the inner coating wall of the microcatheter. Development of unusual friction during coil delivery may be a sign of damage of the microcatheter inner wall and the device should be discarded.
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실)
Yonsei Authors
김동준(Kim, Dong Joon) ; 김병문(Kim, Byung Moon) ; 이호준(Lee, Ho Joon)
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